Quiz 17: Alterations in Cognitive Systems, Cerebral Hemodynamics, and Motor Function
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1. Cognitive operations cannot occur without the effective functioning of the brain’s:
a. Pons c. Reticular activating system
b. Medulla oblongata d. Cingulate gyrus
2. Which intracerebral disease process is capable of producing diffuse dysfunction?
a. Closed head trauma with bleeding c. Neoplasm
b. Subdural pus collections d. Infarct emboli
3. What is the most common infratentorial brain disease process that results in the direct destruction of the reticulating activation system (RAS)?
a. Cerebrovascular disease c. Neoplasms
b. Demyelinating disease d. Abscesses
4. What stimulus causes posthyperventilation apnea (PHVA)?
a. Changes in PCO2 levels c. Damage to the forebrain
b. Changes in PaCO2 levels d. Any arrhythmic breathing pattern
5. Posthyperventilation apnea (PHVA) ceases and rhythmic breathing is resumed when levels of arterial:
a. Carbon dioxide increase c. Oxygen increase
b. Carbon dioxide become normal d. Oxygen decrease
6. Cheyne-Stokes respirations are described as a:
a. Sustained deep rapid but regular pattern of breathing
b. Crescendo-decrescendo pattern of breathing, followed by a period of apnea
c. Prolonged inspiratory period, gradually followed by a short expiratory period
d. Completely irregular breathing pattern with random shallow, deep breaths and irregular pauses
7. Vomiting is associated with central nervous system (CNS) injuries that compress which of the brain’s anatomic locations?
a. Vestibular nuclei in the lower brainstem
b. Floor of the third ventricle
c. Any area in the midbrain
8. Which midbrain dysfunction causes pupils to be pinpoint size and fixed in position?
a. Diencephalon dysfunction
b. Oculomotor cranial nerve dysfunction
c. Dysfunction of the tectum
d. Pontine dysfunction
9. What characteristic is a medical criterion of brain death?
a. Akinetic mutism c. Apnea
b. Coma d. Locked-in syndrome
10. A clinical manifestation caused by damage to the lower pons includes an abnormal:
a. Flexion with or without extensor response of the lower extremities
b. Extension response of the upper and lower extremities
c. Extension response of the upper extremities and flexion response of the lower extremities
d. Flaccid response in the upper and lower extremities
11. Which person is at the greatest risk for developing delirium?
a. An individual with diabetes celebrating a 70th birthday
b. A depressed Hispanic woman
c. An individual on the second day after hip replacement
d. A man diagnosed with schizophrenia
12. A sudden, explosive, disorderly discharge of cerebral neurons is termed:
a. Reflex c. Epilepsy
b. Seizure d. Convulsion
13. A complex partial seizure is described as:
a. Alternating of tonic and clonic movements
b. Impairment of both consciousness and the ability to react to exogenous stimuli
c. Focal motor movement without loss of consciousness
d. One seizure followed by another in less than 1 minute
14. Status epilepticus is considered a medical emergency because of the:
a. Loss of consciousness
b. Development of cerebral hypoxia
c. Possibility of a head injury during seizures
d. Decrease in brain metabolism
15. The most critical aspect in correctly diagnosing a seizure disorder and establishing its cause is:
a. Computed tomographic (CT) scan c. Skull x-ray studies
b. Cerebrospinal fluid analysis d. Health history
16. What type of seizure starts in the fingers and progressively spreads up the arm and extends to the leg?
a. Complex-psychomotor seizure c. Generalized seizures
b. Focal (partial) Jacksonian seizure d. Atonic-drop seizure
17. What area of the brain mediates the executive attention functions?
a. Limbic c. Parietal
b. Prefrontal d. Occipital
18. What term describes the loss of the comprehension or production of language?
a. Agnosia c. Akinesia
b. Aphasia d. Dysphasia
19. With receptive dysphasia (fluent), the individual is able to:
a. Respond in writing, but not in speech.
b. Produce verbal speech, but not comprehend language.
c. Comprehend speech, but not verbally respond.
d. Neither respond verbally nor comprehend speech.
20. What is the normal intracranial pressure (in mm Hg)?
a. 5 to 15 c. 12 to 14
b. 7 to 20 d. 80 to 120
21. Cerebral edema is an increase in the fluid content of the brain’s:
a. Ventricles c. Neurons
b. Tissue d. Meninges
22. What type of cerebral edema occurs when permeability of the capillary endothelium increases after injury to the vascular structure?
a. Cytotoxic c. Vasogenic
b. Interstitial d. Ischemic
23. A communicating hydrocephalus is caused by an impairment of the:
a. Cerebrospinal fluid flow between the ventricles
b. Cerebrospinal fluid flow into the subarachnoid space
c. Blood flow to the arachnoid villi
d. Absorption of cerebrospinal fluid
24. Which edema is most often observed with noncommunicating hydrocephalus?
a. Metabolic c. Vasogenic
b. Interstitial d. Ischemic
25. Which dyskinesia involves involuntary movements of the face, trunk, and extremities?
a. Paroxysmal c. Hyperkinesia
b. Tardive d. Cardive
26. Antipsychotic drugs cause tardive dyskinesia by mimicking the effects of increased:
a. Dopamine c. Norepinephrine
b. Gamma-aminobutyric acid d. Acetylcholine
27. The existence of regular, deep, and rapid respirations after a severe closed head injury is indicative of neurologic injury to the:
a. Lower midbrain c. Supratentorial
b. Pontine area d. Cerebral area
28. What type of posturing exists when a person with a severe closed head injury has all four extremities in rigid extension with the forearms in hyperpronation and the legs in plantar extension?
a. Decorticate c. Spastic
b. Decerebrate d. Cerebellar
29. Since his cerebrovascular accident, a man has been denying his left hemiplegia. What term is used to describe this finding?
a. Visual agnosia c. Amusia agnosia
b. Anosognosia d. Agraphia agnosia
30. After a cerebrovascular accident, a man is unable to either feel or identify a comb with his eyes closed. This is an example of:
a. Agraphia c. Anosognosia
b. Tactile agnosia d. Prosopagnosia
31. Most dysphasias are associated with cerebrovascular accidents involving which artery?
a. Anterior communicating c. Circle of Willis
b. Posterior communicating d. Middle cerebral
32. Tactile agnosia is related to injury of which area of the brain?
a. Frontotemporal c. Temporal
b. Parietal d. Broca area
33. Neurofibrillary tangles characterize which neurologic disorder?
a. Dementia syndrome c. Alzheimer disease
b. Delirium d. Parkinson disease
34. The body compensates for a rise in intracranial pressure by first displacing the:
a. Cerebrospinal fluid c. Venous blood
b. Arterial blood d. Cerebral cells
35. Stage 1 intracranial hypertension is caused by the:
a. Loss of autoregulation that normally maintains constant blood flow during changes in cerebral perfusion pressure
b. Displacement of cerebrospinal fluid, followed by compression of the cerebral venous system
c. Vasoconstriction of the cerebral arterial system with reciprocal increase in systemic blood pressure
d. Compression of the medulla oblongata in the brainstem by herniation of the cerebral cortex
36. Dilated and sluggish pupils, widening pulse pressure, and bradycardia are clinical findings evident of which stage of intracranial hypertension?
a. 1 c. 3
b. 2 d. 4
37. Dilation of the ipsilateral pupil, following uncal herniation, is the result of pressure on which cranial nerve (CN)?
a. Optic (CN I) c. Oculomotor (CN III)
b. Abducens (CN VI) d. Trochlear (CN IV)
38. Which characteristic is the most critical index of nervous system dysfunction?
a. Size and reactivity of pupils c. Motor response
b. Pattern of breathing d. Level of consciousness
39. Diagnostic criteria for a persistent vegetative state include:
a. Absence of eye opening
b. Lack of subcortical responses to pain stimuli
c. Roving eye movements with visual tracking
d. Return of autonomic functions such as gastrointestinal function
40. Uncal herniation occurs when:
a. The hippocampal gyrus shifts from the middle fossa through the tentorial notch into the posterior fossa.
b. The diencephalon shifts from the middle fossa straight downward through the tentorial notch into the posterior fossa.
c. The cingulate gyrus shifts under the falx cerebri.
d. A cerebellar tonsil shifts through the foramen magnum.
41. Which assessment finding marks the end of spinal shock?
a. Return of blood pressure and heart rate to normal
b. Gradual return of spinal reflexes
c. Return of bowel and bladder function
d. Evidence of diminished deep tendon reflexes and flaccid paralysis
42. Characteristics of primary motor neuron atrophy include:
a. Loss of sensation in distal, proximal, or midline muscles
b. Fasciculations and muscle cramps
c. Flaccid paralysis with paresthesia
d. Spastic paralysis with increased deep tendon reflexes
43. The weakness resulting from the segmental paresis and paralysis characteristic of anterior horn cell injury is difficult to recognize because:
a. Upper motor neurons are involved.
b. The injury is microscopic.
c. Two or more nerve roots supply each muscle.
d. The person is unable to feel the involved muscles.
44. Parkinson disease is a degenerative disorder of the brain’s:
a. Hypothalamus c. Frontal lobe
b. Anterior pituitary d. Basal ganglia
45. Clinical manifestations of Parkinson disease are caused by a deficit in which of the brain’s neurotransmitters?
a. Gamma-aminobutyric acid c. Norepinephrine
b. Dopamine d. Acetylcholine
46. Tremors at rest, rigidity, akinesia, and postural abnormalities are a result of the atrophy of neurons in the brain’s:
a. Caudate that produces serotonin
b. Putamen that produces gamma-aminobutyric acid
c. Substantia nigra that produces dopamine
d. Hypothalamus that produces acetylcholine
47. Dementia is commonly characterized by the deterioration in which abilities? (Select all that apply.)
e. Decision making
48. The clinical manifestations of Parkinson disease include: (Select all that apply.)
a. Fragmented sleep
b. Drooping eyelids
d. Muscle stiffness
49. In Parkinson disease the basal ganglia influence the hypothalamic function to produce which clinical manifestations? (Select all that apply.)
a. Inappropriate diaphoresis
b. Gastric retention
e. Urinary retention